[{"_1":2,"_99":-5,"_100":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,75,87],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},"mediaId",6352301,"mediaKeyId","2224992-8f6c90a613f860d4f31b1d43e283141d","parentId",2224992,"title","Department of Mental Health expands alternatives to emergency departments; seeks sustainable funding as pilot grants expire","audioSeconds",1357,"startMs",1125000,"endMs",2482000,"viewUrl","/Search/View?dp=1&key=2224992-8f6c90a613f860d4f31b1d43e283141d&start=1125&end=2482","thumbnailUrl","https://assets.pipeline.soar.com/2224992-8f6c90a613f860d4f31b1d43e283141d/thumbnail_1125000.jpg","articleUrl","/articles/6352301/Vermont/Department-of-Mental-Health-expands-alternatives-to-emergency-departments-seeks-sustainable-funding-as-pilot-grants-expire","mediaUrl","https://secure.pipeline.soar.com/6352301-a95ae3aeadfa8638818ddd4f91e08c7f/orig.mp4?Expires=1771174564&Signature=KyXrzV-KBIp1fCk5O20A~sKIow~0RxRLCm5kcZEbxgKEMqlYq8~4DmbOw4ry8J~mRR~UmSTYuWV8aP9iPOVsvKA5D0JpnJQSD3Bw1e5Yn0yAdAusRzdWGGli12uDgSBcE21T6zCRs1ElSKfbGXN3C6r-CB-exbxwvCaRDxQHQTAF~npy8RboLu7kdwGhfwikVElAkDyUYLo4bBBaAyweLTmqMdQHdYVYZr9P8cWOGd1fl4Sc2Z1b5qzBHi5ExwWbANnYMp1Pzdx8JbI5mvl2pyiEb0oLVg4QwEpGFcXQFFP72dSpcZOWutYmc9o9VaTs9ofGKcxbkj2XTgnWKbE5eQ__&Key-Pair-Id=KUT5TJCACFTXG","author","","date","2025-02-05T17:07:30.503Z","article","Department of Mental Health officials told the House Appropriations Committee on Feb. 5 that Vermont has a patchwork of \"alternatives to emergency departments\" (sometimes called mental health urgent cares) and that the state is working to expand and align those programs with 988 and enhanced mobile crisis services as current grant funding expires.

\"Alternatives to emergency departments is a critical piece of what is needed in our community,\" Deputy Commissioner Samantha Swee said, emphasizing that these programs let people seek crisis screening and supports in a community setting rather than at a hospital emergency room.

Why it matters: Department witnesses told the committee these alternatives can shorten the time to connect people with a designated agency and provide more therapeutic spaces than emergency rooms. Funding that currently supports many programs flows from HCBS FMAP dollars; that grant funding ends in March 2026. The department said it is requesting roughly $800,000 for the last quarter of FY2026 to sustain and evaluate the programs and to develop a regional approach.

Scope and locations: Swee and other presenters listed several programs across the state: Interlude (Addison County; adults only), Front Porch (Northeast Kingdom; all ages), Access Hub (Washington County; adults only), Howard Center's Mental Health Urgent Care (Chittenden County; adults only), psychiatric urgent care for children (PUC) by United Counseling Services in Bennington (ages 3\u0001218), EPIC in Lamoille County (youth), a youth stabilization program in Windham and Windsor counties provided by HCRS, and CARES in Burlington (ages 6 and up), a partnership modeled after CAHOOTS that pairs police with EMT or nurse responders.

Data on timing and capacity: Contrary to some expectations, department staff said most calls and crises occur during daytime and early evening hours rather than overnight. Swee said 988 call data show most calls come before 9 p.m., with a peak window around 7 p.m. to 10 p.m.; very few calls come in during overnight hours. The department also said staffing agencies to extend into evening and overnight remains challenging and that designated agencies continue to operate 24/7 hotlines for immediate response.

Funding and service shifts: Several committee members asked how the programs are funded and whether local outreach positions would be cut. The department said many alternatives-to-ED programs were funded with HCBS FMAP grant dollars that expire March 2026; the Howard Center and Northeast Kingdom models are exceptions already funded differently. Deputy Commissioner Swee explained the department anticipates a shift from small, town-based general-fund outreach positions to an enhanced mobile crisis model that is Medicaid-billable and can provide a two-person 24/7 response team (often including a peer) and statewide dispatch via 988. \"What we see here is a natural shift in what used to be non-billable to what's billable, and the 24/7 support for communities,\" Swee said.

Planned reductions and reallocation: The department identified a proposed reduction to the Howard Center community outreach line (general fund) that officials described as a reallocation rather than an elimination: the outreach functions outside Burlington will be rolled into the enhanced mobile crisis capacity so the services are billable and available at greater scale. The committee was also told an embedded clinician position in some pediatric offices has been vacant for years and the department proposes reallocating those limited resources toward systemwide functions that ensure families are connected to insurance and community providers.

Ending: Department officials asked the committee to consider short-term funding to bridge the grant expiration and to let the state analyze what program models work regionally before committing to a permanent expansion. Committee members pressed for further data on capacity, hours of operation and costs as the Appropriations Committee considers base funding and whether to convert grant-supported pilots into recurring appropriations.","mediaType","Video","parentTitle","House Appropriations - 2025-02-05 - 10:00AM","oneSentenceSummary","Department of Mental Health officials told the House Appropriations Committee on Feb. 5 that Vermont has a patchwork of community \"alternatives to emergency departments\" and is working to align them with 988 and enhanced mobile crisis teams as grant funding expires in March 2026.","taxTitle","Appropriations, HOUSE OF REPRESENTATIVES, Committees, Legislative , Vermont","taxId",30573,"location","Vermont","headline","shortSummary",{"_33":76,"_35":36,"_37":38,"_39":77,"_41":78,"_43":79,"_45":80,"_47":81,"_49":82,"_51":83,"_53":84,"_55":56,"_57":58,"_59":85,"_61":62,"_63":64,"_65":86,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},6352306,"Vermont picks two agencies to begin CCBHC certification under federal demonstration",359,372000,731000,"/Search/View?dp=1&key=2224992-8f6c90a613f860d4f31b1d43e283141d&start=372&end=731","https://assets.pipeline.soar.com/2224992-8f6c90a613f860d4f31b1d43e283141d/thumbnail_372000.jpg","/articles/6352306/Vermont/Vermont-picks-two-agencies-to-begin-CCBHC-certification-under-federal-demonstration","https://secure.pipeline.soar.com/6352306-3ba97885b9342fdcd23116ac2fda9df2/orig.mp4?Expires=1771174564&Signature=Y3-JQS0F0nDioiLZweWRMHSw4lfvB8~yrixT0QSzawDnXS0pnsqfFzbAIauD5siRhURFxe8DgDZcetHCXxqvuVdBpVl1-lMLJTHqLWqxeeQm4L3-M5bHu~FY9xmITNHXLzohA7MU6yNscF2k~TAQcKWsghgPy37ZIvRWdcEy5KISnQR30LLZHxu1Jp8ZyRcVHt8R5c14mFax5ctNJrg-7hk3lJJhwGFgSeWMe9Hc~n91t08AEWRwdFfr~7YyzjYMdsQhtXagb4ET08gnYMlTzDhleR5ObFfqM8TYxIuuNENSllhKL1Acq2YP-yS4AqBKDAZSXkmCkQ8vYszBFlgHlA__&Key-Pair-Id=KUT5TJCACFTXG","The Vermont Department of Mental Health told the House Appropriations Committee on Feb. 5 that it will begin implementing the certified community behavioral health clinic (CCBHC) model in two agencies as part of a federal demonstration that increases federal match for integrated mental health and substance use disorder services.

Commissioner Emily Hawes said the CCBHC model aims to expand access to evidence-based substance use disorder treatment, mental health services, 24/7 crisis response and medication assisted treatment for opioid use disorder. \"This model requires agencies to meet a robust criteria regarding timeline of access, quality reporting, staffing, coordinating with local services and education systems,\" Deputy Commissioner Samantha Swee said.

Why it matters: The CCBHC model is a national approach designed to broaden access to integrated care and offer more predictable funding through a daily or per-capita rate under some demonstration arrangements. In Vermont's demonstration status, the department said it can access \"an enhanced federal drawdown for those services delivered within the CCBHC model,\" Swee said.

Implementation timeline and sites: The department awarded planning grants beginning in 2021 and completed a competitive process to identify the first two agencies to certify. \"Those two agencies are the Claire Martin Center and Rutland Mental Health Center. Those two agencies will begin operating under the CCBHC model in July 1,\" Swee told the committee. Howard Center, HCRS and Northeast Kingdom Human Services are planning to pursue certification as well, the department said.

Model details discussed during the hearing included the following points:
- The CCBHC rate in Vermont's demonstration is not a per-encounter fee-for-service; Swee described it instead as a daily rate and part of a flexible funding approach negotiated with agencies during the demonstration.
- The model is intended to increase access for veterans and to include peer services (people with lived experience) as part of the staffing mix.
- The department emphasized that some services, such as residential programs, exist outside a CCBHC rate and may be billed separately.

Questions from committee members addressed scope and data: Representative Lohre asked what portion of mental health cases are co-occurring with substance misuse; Swee said adult clients commonly have co-occurring disorders and estimated \"80, 90 percent\" of adults interacting with the mental health system also use substances, acknowledging that that figure comes from billable-service data and primary diagnosis reporting. Representative Giacalone asked whether CCBHCs are similar to intensive wraparound services; the department clarified that CCBHCs are not limited to wraparound family programs and that residential services generally sit outside the CCBHC rate.

Ending: The department said two agencies will begin certification on July 1 under federal demonstration terms and that other designated agencies are actively preparing for certification; committee members pressed for additional details about the rate methodology and how residential and wraparound services will coordinate with CCBHC billing.","The Department of Mental Health said Claire Martin Center and Rutland Mental Health Center will start operating under the certified community behavioral health clinic model on July 1 as part of a federal CCBHC demonstration that provides enhanced federal drawdown for integrated mental health and substance-use services.",{"_33":88,"_35":36,"_37":38,"_39":89,"_41":90,"_43":91,"_45":92,"_47":93,"_49":94,"_51":95,"_53":96,"_55":56,"_57":58,"_59":97,"_61":62,"_63":64,"_65":98,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},6352311,"Department of Mental Health separates facilities budget, requests authority for rising costs and program shifts",682,2352000,3034000,"/Search/View?dp=1&key=2224992-8f6c90a613f860d4f31b1d43e283141d&start=2352&end=3034","https://assets.pipeline.soar.com/2224992-8f6c90a613f860d4f31b1d43e283141d/thumbnail_2352000.jpg","/articles/6352311/Vermont/Department-of-Mental-Health-separates-facilities-budget-requests-authority-for-rising-costs-and-program-shifts","https://secure.pipeline.soar.com/6352311-44ce89a7e93ff30e85195d53fd8f6ce8/orig.mp4?Expires=1771174564&Signature=kVGreHwLhtWOT0BTUyoP9uDRbkuCeYEHqYNVd-TUaocnB2a7mdkG1xZYnrN3quGuowlI63av9NKdJG6nGwCJmHdHjb~DgyQe5P2nthS7rdy31IqHIEa0F2XNexv7kBkv3cnO7iomOGso1JKV-TL96gAQUCN3QO~cS05cgXyTgO~9bD0cM5iN7DN555i0k9SG7kQ-cxxugMGpgxsZFAVHrrRIAf1OZ9Em9ojoxb7OeOXyLai7kN7Q5R3dPm7zbjUol2B1Buz12Qy76F0aAC5OCwUndUdlypiwgI0iIWq8xyRgqEi0kGToy1rDw6iflF3PAxXi14CdROvQUe94tAgSHg__&Key-Pair-Id=KUT5TJCACFTXG","The Vermont Department of Mental Health asked the House Appropriations Committee on Feb. 5 to approve a restructured budget that separates central office functions from facility operations and to authorize transfers and increased federal spending authority to match changing program demands.

The reorganization aims to show more clearly what the state spends on the Vermont Psychiatric Care Hospital and the River Valley Therapeutic Residence versus central office operations, Shannon Thompson, the department's financial director, said. \"We are separating out the overall Department of Mental Health budget into two different appropriations,\" Thompson said.

Committee members were shown that the department plans to transfer $38,681,170 in personal services from the central office appropriation into the facilities appropriation. Thompson said the split is intended \"for transparency purposes so you can see really what we're spending on those two facilities versus our central office and the rest of the system.\" The department also described its overall funding mix as dominated by Medicaid and the Global Commitment, with roughly 9% general fund in the current chart.

Why it matters: Separating facilities from central office spending changes how legislators and the public will see personnel and operating costs tied to inpatient care and secure residential services. The committee heard that much of the department's spending flows through federal Medicaid Global Commitment and grant funding, meaning state exposure and federal match rates affect long-term stability.

Among the detailed line items Thompson and the department highlighted:
- A transfer of $38,681,170 from central office personal services into the facilities appropriation.
- Vacancy-savings in central office are roughly in the 4% range, Thompson said in response to a committee question.
- The Vermont Psychiatric Care Hospital (VPCH) was listed at about $34.5 million in current-year spending; River Valley Therapeutic Residence about $9 million; and an inpatient bucket shown separately.
- The Success Beyond 6 program carries authority of $72,000,002.50, while actual annual spending has generally been closer to the $60 million range, Thompson said; the program is funded by a mix of Medicaid and general fund with schools providing the local match flow-through.
- Private nonmedical institution (PNMI) spending includes an increase of $822,304, which the department tied to higher utilization of residential placements for adolescents, with both in-state and out-of-state placements referenced.

The department told the committee it has begun moving some Global Commitment Investment funds and making technical corrections among fund sources to align its cost allocation. Thompson also said some CNMI (likely PNMI) pressures and inflationary rate-setting adjustments are showing up in the request.

Discussion and context: Committee members, including Representative Lewin, asked about vacancy savings and whether salary or new positions drove increases. Thompson said salary and fringe changes reflect pay acts and standard personnel cost changes and that additional detail could be discussed in follow-up briefings. Commissioner Emily Hawes and Deputy Commissioner Samantha Swee also answered policy and service questions during the hearing.

The department indicated it will seek federal spending authority in the fiscal adjustments act (BAA) for programs already approved but lacking appropriation-level authority in the base budget. It also flagged that certain grant funding (HCBS FMAP) currently supporting alternatives-to-ED programs expires in March 2026, prompting a base ask of roughly $800,000 for the last quarter of FY2026 to preserve services while the state analyzes longer-term options.

Ending: Committee members said they would review the appropriation split and follow up on questions about vacancy savings, PNMI trends, and the mechanics of Success Beyond 6 funding. Thompson said staff and the department remain available for more detailed budget discussions as the committee works through the appropriation language.","Vermont Department of Mental Health told the House Appropriations Committee it will split central office and facility spending into separate appropriations, move $38.7 million in personnel costs into the facilities appropriation, and asked for additional spending authority tied to federal funding streams amid rising residential and PNMI demand.","actionData","errors"]

Article not found

Department of Mental Health expands alternatives to emergency departments; seeks sustainable funding as pilot grants expire

Vermont picks two agencies to begin CCBHC certification under federal demonstration

Department of Mental Health separates facilities budget, requests authority for rising costs and program shifts